#18 - Intro to Pulmonary

Question 1

3 ways that dyspnea is defined

Answer 1

1-excessive work of breathing

2- air hunger

3 - chest tightness

Question 2

Wheezing on physical exam signifies

Answer 2

narrow airway (eg, asthma)

Question 3

Rales (crackles) on physical exam signify

Answer 3

pulmonary infiltrate (fluid in the alveoli)

Question 4

What is the normal value for FEV1/FVC

Answer 4

70% and above

Question 5

You see a patient in clinic whose spirometry suggests obstructive lung disease. You give him 2 puffs of albuterol (bronchodilator) then do it again. His FVC goes from 1.0L to 1.15L. Is this enough to diagnose asthma?

Answer 5

No. He needs to have a 12% increase AND 200mL increase in either his FEV1 or FVC. This is a 15% increase but only 150mL

Question 6

What are teh criteria to separate asthma from COPD on a bronchodilator response?

Answer 6

After receiving albuterol, Patient needs to have a 12% increase AND 200mL increase in EITHER his FEV1 or FVC.
If these criteria are met, it is asthma. If not-COPD

Question 7

T/F :

The standard FEV1/FVC cutoff of 70% leads to overdiagnosis in the young.

Answer 7

False. Leads to underdiagnosis in the young, and overdiagnosis in the old.

Alternate cutoff = 5th percentile of reference range for patient’s age.

Question 8

“capacities” in general, are

Answer 8

sums of volumes. Volumes can not be broken into smaller components.

Question 9

What volume, and which capacity cannot be measured by spirometry along?

Answer 9

reserve volume, and total lung capacity (which includes all the volumes, including reserve volume.

Question 10

T/F Spirometry can make the diagnosis of an obstructive or restrictive disease.

Answer 10

FALSE.

It can only diagnose an obstructive physiology (FEV1/FVC ratio

Question 11

Which test can you perform to find out reserve volume / TLC?

Answer 11

helium dilution test.

Question 12

Give the three categories of factors that can impact gas diffusion at the alveoli

Answer 12

1-decreased surface area

2-decreased pressure (obstruction, eg asthma)

3- increased diffusion distance between alveolus and capillary (fibrosis, edema)

Question 13

Hypoxia vs. hypoxemia

Answer 13

hypoxia= reduced partial pressure of oxygen in the alveolus
hypoxemia = reduced oxygen content in the blood

Question 14

What is a normal O2 sat

Answer 14

> 95%

Question 15

What significance is the alveolar-capillary oxygen gradient?

Answer 15

the larger the A-a diference, the more severe the pathology (normally,